Doctor refused

[Jessica078 0]

My primary doctor refused to give me a referral for wls she doesn't believe In the surgery any advised I'm in Orlando FL.
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[Healthy_life2 8,330]

25 minutes ago, Jessica078 said:

My primary doctor refused to give me a referral for wls she doesn't believe In the surgery any advised I'm in Orlando FL.
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Wow that is frustrating. Might want to try going to another physician.

[Apple203 1,314]

34 minutes ago, Jessica078 said:

My primary doctor refused to give me a referral for wls she doesn't believe In the surgery any advised I'm in Orlando FL.
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I believe you can get a second referral from any the specialists you see before surgery.

[Little Green 583]

I didn't need a referral. I saw my PCP about 3 months after my consult and said, "I'm having bariatric surgery, here are my plans." (She was and is super supportive, thank goodness!) Many PPO insurance plans don't require referrals, so check that out before you find another doc and pay a copay.

I'm usually against doctor hopping but unfortunately many still stigmatize WLS when it's the only thing shown to work for this population. In this specific instance I would definitely recommend finding a new PCP if your insurance requires a referral.

[Jessica078 0]

I didn't need a referral. I saw my PCP about 3 months after my consult and said, "I'm having bariatric surgery, here are my plans." (She was and is super supportive, thank goodness!) Many PPO insurance plans don't require referrals, so check that out before you find another doc and pay a copay.
I'm usually against doctor hopping but unfortunately many still stigmatize WLS when it's the only thing shown to work for this population. In this specific instance I would definitely recommend finding a new PCP if your insurance requires a referral.

Thanks yes my insurance requirements is to get a referral from your pcp

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[BRAY 2]

Thanks yes my insurance requirements is to get a referral from your pcp

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[BlueCrush 408]

You may not want to hear this, but if you have a true referral - driven H M O plan, it's likely that your doc gets financial incentives by keeping your medical costs down (i.e. keeping the insurance company's medical spend down). It's called risk - share contacting. This may be the reason they're against bariatric surgery, as in the short term it increases your costs as a patient and thus decreases their quarterly reimbursement from the insurance company.

(edit: why is H M O... As in health maintenance organization... a filtered word that comes across asterisks?)

Edited February 14, 2018 by BlueCrush

[Creekimp13 5,841]

Did your PCP give you a reason? Do you meet bmi requirement, etc?

[Jessica078 0]

She doesn't believe in the surgery

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[Kat0000 124]

Honey change docs. Its not up to them to control your life. If YOU meet requirements make a fast change. I have a PCM. ONLY saw him twice and said i want wls. I actually did this today and he put in a referral for me and said it should be no problems being authorized. I have a INS thru tricare east. We are military. If he would of said no due to his OWN BRIEFS, I would of 2 options, turning to a patient advocate or change to another PCM in a hot minute. Its about what your ins will do not his damn beliefs.....

Edited February 14, 2018 by Kat0000

[Jessica078 0]

You're right thank you

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[Sosewsue61 3,185]

Change PCP and Dr's report to an office manager, after you get a referral I would complain - opinion is not 'science'. Ask the Bariatric surgeon in your plan for a PCP that is supportive. Good luck.

[NegreteLove 52]

She doesn't believe in the surgery

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Contact your IPA or *** and ask for a nurse case manager to look over your records. The NCM may advocate for you to have the surgery and that would over-ride the PCPs decision.

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[kakatlady612 1,053]

Jessica--- she doesn't believe in the surgery and can't give you a valid reason why? Time for you to sever ties, move on to a PCP that will truly care and be there for you. I'm lucky, I have a great PCP, when I told him I was considering it, he sat down with me, gave me advice as to what program his previous patients had used and which program he felt was best for me, wrote me a letter of referall and is one of my biggest cheerleaders in this endeavor.

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[elforman 234]

On 2/13/2018 at 6:21 PM, Jessica078 said:

She doesn't believe in the surgery.

Whether the doctor believes in something or not is irrelevant. The only real question is whether WLS is medically indicated for you. And also important is whether the doctor said anything else about why she thinks you are specifically not a good candidate or if she just thinks it's not warranted for any of her patients.

If you don't mind sharing, do you know your current BMI? (If you don't you can find an online calculator.) The general rule of thumb, at least for sleeve, is 1) minimum of 40 or 2) between 35 and 39 if there are other complicating medical conditions such as diabetes or severe sleep apnea. If you don't meet either of those criteria you might not have a case. But if you do and the doctor refuses to submit a referral, you could go over the doctor's head and contact the medical director where the doctor practices to report her. You can also contact your insurance company and let them know that your doctor is failing to follow proper medical protocols.